principles above propounded to the details of disease under its multifarious forms, and the best method of encountering and, if possible, relieving and removing it. The third book, accordingly, is occupied with the twenty-two radical diseases, already catalogued, in so many distinct chapters; the fourth, with common continued fevers; the fifth, with periodic endemic fevers, and the sixth with acute inflammatory diseases, whose consideration, if at all, must be reserved for a future opportunity. Meanwhile we feel entitled neither to ask the judgment of others, nor to volunteer our own-definite and conclusive-as to the merits of this work. We have been much struck with its originality, with its rich store of facts, and the industry and success with which they have been grouped and generalized. We have also been surprised to find that the whole plan is so ingenious, pregnant with thought, and endowed with good sense and sound discretion. We have throughout, ourselves been anxious to follow an advice preferred by M. Lanza, which we recommend to all: "Let the reader examine with a kindly spirit what we have proposed as the best method of studying disease in a positive way; let every one endeavour to find a better,-we doubt not there are many,―e viva felice !"

ART. III.

Elements of Pathological Anatomy; illustrated by Coloured Engravings and Two Hundred and Fifty Woodcuts. By SAMUEL D. GROSS, M.D., Professor of Pathological Anatomy in the Medical Department of the Cincinnati College, &c. Second edition.-Philadelphia, 1845. Large 8vo, pp. 822.

WE have, in our first Article, noticed an important work of Dr. Gross, published four years since. The present one is of more recent date.

It seems a remarkable fact that the literature of Great Britain does not possess a complete treatise on morbid anatomy. The Elements of Pathology' of Mr. Mayo must rather be regarded as a series of notes, than as actually a work, on the subject; besides, throughout its pages the impress of the special surgical pursuits, tendencies, and style of knowledge of the author may be found prevailing to the detriment of the purely medical divisions of his topics. Dr. Hodgkin's treatise, elaborately worked out as far as it goes, is but a fragment; and such, we fear, it is ever likely to remain. Dr. Carswell's fasciculi, models in their way, leave a multitude of subjects either untouched altogether, or but very lightly handled. Besides, no single one of these works contains any account of the microscopic appearances of diseased parts and products. Their publication dates, indeed, before the era of modern or true micrology. Much they contain has been proved absolutely erroneous from the revelations of this, as yet, short-lived era-much, too, requires remodelling and rearranging.

But the deficiency of a work on morbid anatomy, brought up to the level of existing knowledge, is neither traceable to individual apathy towards the subject, or inaptitude for the task of its production. There are not a few persons in London at this moment whom we believe both zealous enough and learned enough to accomplish the labour, both with honour to themselves and advantage to their brethren. But these persons

seem, naturally enough, disposed to invest their talents in capital more likely to supply a remunerating profit. Experience and inquiry show them that works on morbid anatomy are not prone to return even the outlay necessary for their production. And so long as the subject continues uncared-for in what it is the fashion to style "high places," this must continue to be the case. Few things connected with medical education in this country are more striking than the total indifference on the part of examining boards, as to whether those to whom they grant their diplomas possess even rudimentary knowledge in the facts and principles of this science. Candidates for the licence to treat disease in the human species are required to know minutely the anatomy and physiology of plants, and of the textural changes produced by disease in man it is not cared how ignorant they may be. Youths are peremptorily required to be "thoroughly up" in that which, in nine hundred and ninety-nine of a thousand cases, their subsequent lives will afford them no opportunity of employing, namely, a knowledge of the mode of life of vegetables; they may luxuriate in deficiency, more or less complete, of that on which much of their utility as practitioners of medicine must hereafter depend, namely, a sound knowledge of the nature, sequence, and influence of the anatomical changes preceding, accompanying, or following the development of disease. Hence it is that in no department of medical science does ignorance so generally prevail as in morbid anatomy-a fact of which illustration is too often publicly afforded by evidence given in the courts of law, and (more innocently in respect of consequences) by the "reports" of ambitious tyros in the pages of our medical journals.

As Examining Corporations neglect morbid anatomy-as they do not accord it its due weight and importance as an element of practical education-the majority of medical schools, of course, care not how profoundly ignorant their alumni may remain of its mysteries. The prospectuses of some schools make no mention of the subject at all. Conscious of their deficiency in the reality, the conductors of these establishments make no attempt to produce the semblance of giving instruction in its principles. In the announcements put forth by other schools, instruction in morbid anatomy is advertised by the teacher of some one or two other branches (of which branches, be it remembered, he has scarcely time to expound the facts); and the advertised promise is kept by the chance introduction, some twenty times or so during the course, of allusions, sufficiently profound and mysterious, to John Hunter and coagulable lymph. We appeal to these very teachers themselves, if this be not an unexaggerated statement of their mode of proceeding. We remember, now many years since, meeting the late Dr. Macartney at Paris, to have fallen into conversation with him on the relative conditions of home and foreign medical instruction. The Irish Professor could not contain his indignation at what he called the division and subdivision of subjects at the Parisian School of Medicine. "What outrageous absurdity it is," he exclaimed, "their having distinct professorships of descriptive anatomy, comparative anatomy, surgery, and morbid anatomy! Why, sir," said the doctor, "I have taught every one of these subjects in one course every year for the last twenty years, and I always had time enough, and to spare!!" There are but two schools, we believe, in London where separate teacher

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ships of morbid anatomy exist; and here, unless our informants have sadly deceived us, the students exhibit their deference for the opinions of the great Examining Corporations-they neglect the teachers. It is, indeed, matter of notoriety that no one has ever succeeded in what is technically termed "making a class" in morbid anatomy in London.

But it may be said that the Society of Apothecaries includes "morbid anatomy" in its curriculum. We admit this, and we give that body full credit for their good intentions: this is not the only instance in which the lowest of the three medical estates has set a good example, which the others have scorned to follow. But good intentions are one thing, and good deeds another. It is well known the desire of the Apothecaries' Company concerning morbid anatomy is virtually a dead letter. Actuated by some evil influence or other, the examining body accepts as evidence of instruction in morbid anatomy the attendance on hospital practice; and thus utterly does away with the intent of those who recognize the importance of serious and systematic study of disease and of morbid changes. Under the present state of things, any pupil who has entered to "hospital practice" obtains his "certificate for morbid anatomy" (though he may never have seen more than a body or two opened) from any one of the hospital physicians!

Despairing then, as we do, for the present at least, of the appearance of a work on morbid anatomy of British manufacture, we have felt no little pleasure in receiving from a transatlantic school the bulky volume of Dr. Gross. This treatise has reached a second edition; and the tribute to its merit thus implied is, within certain limits, not undeserved. Deficient altogether in original facts or views, exhibiting no particular quality of ingenious inference, occasionally mistaken in the statement of opinions and conclusions, incorrect in the allotment of discoveries to their authors, and not unoften displaying want of acquaintance with the existing state of advancement of European science, the volume, nevertheless, is free from errors of importance, and contains a plain and succinct account of the chief facts of morbid anatomy. Dr. Gross, in arranging his materials, has followed the plan of Andral, Carswell, and many others-that of first describing the various morbid states, which occur in the body, by themselves; and then, in connexion with each tissue and organ, dwelling upon the peculiarities which distinguish them therein.

"All diseases, I feel

Dr. Gross is a disbeliever in dynamic diseases. confident, will ultimately be found to have a local origin and habitation;' and if this opinion shall ever be proved to be true, the whole class of febrile maladies, with its hundred varieties and subdivisions, will cease to have a place in our medical treatises." (p. 26.) We fully coincide in the views here expressed; our admission of dynamic diseases at the present day is merely provisional, and becomes from day to day almost less necessary, in consequence of the discovery of organic causes for numerous diseases presumed formerly to be merely functional.

Dr. Gross holds a doctrine concerning the effusion of serum, the heterodoxy of which is not relieved either by its own plausibility, or by any ingenious argumentation on the part of the author. Serous effusion,"

says Dr. Gross, "is the result of inflammation, usually of a very mild grade. That this is true, as a general rule, cannot be doubted; the ex

ceptions, if there be any, are certainly very rare, and have not yet been satisfactorily pointed out." He regards anasarca, for example, of the limbs produced by venous obstruction, as a result of inflammation in the actual part in which the serous effusion occurs. There is, according to him, no such thing as simple mechanical oedema. The sole arguments put in requisition to support his notion are, that (1) the anatomical signs of inflammation may be deficient, or imperceptible, in parts where that process has existed; and (2) when obstruction of a large vein takes place, "the blood is interrupted in its circulation, and congestion of all the vessels, both large and small, is the result. This congestion is not transient, but permanent; and it is scarcely reasonable to presume, judging from our knowledge of the circulation, that this state could exist long without producing an altered condition of the sensibility of the parts affected, attended with more or less redness and effusion of serosity." This is sufficiently hollow reasoning. And, as often happens with propounders of inadmissible notions, the author himself absolutely relinquishes his crotchet (inadvertently, we doubt not) in the very next page; where we find him concluding his inquiry with a statement that serous effusion "is the result invariably of a process analogous to, if not strictly identical with, inflammation." (p. 45.) Here the whole position, against which the author contends, is conceded. Everybody knows that there must, ex natura rerum, be analogy between some of the phenomena occurring in the inflammatory and mechanical processes of serous effusion; but analogy is not identity.

Much of Dr. Gross's volume relating to the subject of inflammation and its effects would be unintelligible, unless upon the understanding that he employs the term organization as synonymous with vascularization. Such employment of the terms would carry us back in pathology more than we should have expected to have been carried back under the conduct of Dr. Gross. The day has passed when the possession of vessels was mistaken for a sine qua non of the organization of an animal substance. Epithelium is surely organized, and the transparent cornea is among the most beautiful specimens of organization the animal body contains; yet vascularity exists in neither the one or the other. Nor does Dr. Gross appear to us happy in his sketch of the mode in which the vessels of solidifying coagulable lymph are produced. The sketch is too sketchy; the real points of anatomical difficulty are scarcely glanced at. But we hold him to be right in his exposure of the pertinacity with which French surgeons refuse to admit the practice of closing amputation and other wounds by first intention. In all probability they will continue to jeopardize (to say the least) the lives of their countrymen by their refusal, until some crafty and most learned Parisian shall have discovered that the practice in question originated in France, and not among "nos chers confrères d'outremer," as we on this side the Straits of Dover are affectionately styled.

Dr. Gross seems particularly fond of detecting and exposing lurking inflammation in conditions where others are agreed that it does not exist. In hemorrhage by transudation, under the influence of mechanical obstruction, he discovers inflammation. At least he doubts whether it does not exist. And upon what evidence? Upon the analogical argument

that during menstruation " many women undergo great suffering, labouring under all the symptoms which indicate the presence of inflammation.” That the symptoms of ordinary dysmenorrhea are those of an inflammatory state we altogether deny; while, on the other hand, it should have occurred to Dr. Gross that (as is now well known, thanks to the use of the speculum) actual inflammation of the cervix uteri often exists in women who suffer extremely during the menstrual period.

In speaking of "transformations," Dr. Gross discusses as follows a question of some interest. The passage affords a good specimen of his style and manner :

"Is the osseous transformation, when it takes place in the cellular tissue, always preceded by the fibrous and cartilaginous states? Upon this point pathological anatomists are still at variance. If the process be carefully examined, as it occurs in the subserous cellular tissue in different parts of the body, it will be found to involve a series of successive stages corresponding with those that are observed in the foetal skeleton. The first change which this substance experiences is a diminution of its natural transparency, accompanied with a slight degree of thickening of the part, and a deposition of turbid cream-like matter, which is diffused through its aerolar texture. As the morbid process advances, the part becomes more and more opaque, is rendered flexible and elastic, assumes a grayish colour, and grates under the scalpel. It is now distinctly fibro-cartilaginous; it is next converted into cartilage, and finally into bone, the particles of osseous matter being deposited at different points, which gradually augment in diameter; and at length, running into each other, thus completely change the primitive character of the part. The period required for the perfection of each of these changes cannot be determined. In some instances there is reason to believe that it is very short, whilst in others it embraces several months, or some years." (p. 98.)

Dr. Gross has a chapter on "Polypi." We do not believe that in a work on pathological anatomy such a chapter should exist. Polypi possess no special character of structure entitling them to consideration apart in a scientific point of view. The word was originally employed to signify a pecularity of shape or form, and merely this. Polypi are pedunculated masses, composed of structure which is capable of existing in other forms. To us, therefore, it appears that the structure, be it cellular, cellulo-vascular, erectile, or fibrous, &c., should be described generally, and the accidental quality of polypoid shape described as a matter of secondary consequence. The mode of proceeding (the usual one on the part of writers) adopted by Dr. Gross has been productive of the extremely prevalent, and quite as erroneous, notion that the nature of a socalled polypus is peculiar and essential to the fact of its shape. We are still more at variance with Dr. Gross in respect to the views he entertains concerning the "transformations" of polypi. They become carcinomatous frequently, he says; "and, further, the fibrous polypi is by far the most liable to degenerate into malignant [meaning cancerous] disease." (p. 109.) We are well aware that this doctrine has been professed by other persons; but we hold it to be altogether destitute of foundation, as we know it to be destitute of proof. Has Dr. Gross seen true fibrous tumours (polypoid or not), wherein a development of cancerous substance had occurred? If so, we sincerely trust he has preserved the specimens. On this side the Atlantic, at least, they would rank amongst the mirabilia

of morbid anatomy.